Anxiety Attack, Panic Attack & Anxiety Disorder Treatment

8/5/2013

What are anxiety attacks? (otherwise known as panic attacks)

According to the American Psychiatric Association (1994), a panic attack is a period of intense fear or discomfort and consists of 4 or more of the symptoms listed below. Panic attacks have an abrupt onset and the symptoms peak within 10 minutes.

 What are the symptoms of a panic attack?

Panic symptoms include:

• palpitations
• sweating
• trembling or shaking
• shortness of breath
• choking sensations
• chest pain or discomfort
• nausea
• dizziness
• feeling detached from oneself
• fear of losing control or dying
• numbness or tingling
• chills or hot flushes

Some people with panic disorder will have recurrent, unexpected panic attacks. Other people may find that their attacks almost always occur when they are confronting or anticipating particular things or situations . However, another group of panic sufferers find that although they are more likely to have anxiety attacks in certain situations it does not always happen, that is they have ‘good days’ and ‘bad days’.(American Psychiatric Association, 1994).

What is a panic disorder?

People with panic disorder have:

•  recurrent, unexpected panic attacks
• 1 month or more of ongoing concern about having another attack,  OR
• worry  about the implications or consequences of having a panic attack (e.g. losing control, going crazy or being embarassed)
• altered their behaviour because of the panic attacks (e.g. they avoid certain situations or activities which may trigger an attack such  as crowds, driving etc)

The panic attacks cannot be side effects of recreational or prescription drug use or a general medical condition.

The panic attacks are not an associated feature of another mental condition such as  Social Anxiety, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Separation Anxiety or a Specific Phobia.

Who develops panic disorder?

Panic disorder is more prevalent in women, and women are more prone to develop  significant agoraphobia.

Why am I having panic/anxiety attacks?

Research has found that  there is a genetic contribution to the development of  panic disorder. For instance if your mother or father has the condition you have a greater chance of developing the condition than people whose parents do not have the illness. Psychological factors, and stressful life events are also thought to contribute to the onset of panic disorder.

Sometimes people experience anxiety attacks because they have a medical condition.  Health problems which can cause attacks include hyperthyroidism, inner ear complaints, and heart conditions. Therefore if you are experiencing anxiety attacks you should consult a doctor to rule out the possibility that your attacks are due to a  general medical condition, and not panic disorder.

Some people will experience anxiety attacks because  they have been using: cocaine, amphetamines, cannabis, caffeine, alcohol or barbiturates. If the anxiety attacks persist  long after the effects or intoxication or withdrawal have ceased, the person may have  panic disorder.

Sometimes people have attacks because they have another mental disorder such as social anxiety, post traumatic stress disorder or obsessive compulsive disorder. People with social anxiety may have anxiety attacks when in feared social situations (e.g. public speaking, job interviews, meeting new people) and people with post traumatic stress disorder may have anxiety attacks when something reminds them of their traumatic event. Obsessive compulsive disorder sufferers may experience anxiety attacks when exposed to the object of an obsession(e.g. exposure to blood for someone with an obsession about catching AIDS). People with body dysmorphic disorder may have panic attacks when they think someone is looking at them.

What effect can anxiety attacks have on my life?

Given that panic attacks cause intense fear or discomfort, and people may fear they are going to die, lose control, go insane, or have a heart attack, they can end up worrying about having further attacks and therefore start avoiding situations which they think might trigger a panic episode. For example, if someone has their first panic attack in a supermarket they might be apprehensive about going into a supermarket again and start avoiding shopping. People might also avoid standing in queues, being in crowds, travelling across bridges or though tunnels, driving on freeways, travelling on trains, trams, buses, planes and even leaving their home alone, for fear of triggering an attack.

Some people find that their attacks are limited to social scenarios such as job interviews, public speaking, participating in meetings, dating, dealing with authority figures and/or meeting new people — and they may start avoiding these social interactions to the detriment of their careers and/or personal life.

Experiencing anxiety attacks can lead to people not going to school, university or work and if this persists they may withdraw from study or end up unemployed.

Could there be anything else wrong with me, as well as panic disorder?

It is common for people with panic disorder to have other mental conditions such as:

• substance abuse
• depression
• other anxiety disorders

How can I deal with anxiety attacks?

Firstly, if you are experiencing attacks you should consult a doctor to rule out the possibility that your panic attacks are due to a general medical condition. Once your doctor has ruled out physical illnesses as the possible cause of your anxiety attacks, you need to decide whether you will try cognitive behavioural therapy or medication to deal with your condition.

The Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines (2003)  state that cognitive behavioural therapy is more effective in the treatment of panic disorder than medication.

Psychologists and other mental health professionals can provide treatment for panic disorder.

Catherine Madigan, clinical psychologist, offers CBT treatment for panic attacks in Hawthorn, Victoria so call (03) 9819 3671 or 0419 104 284 now for an appointment.

At your first session with a psychologist, they will need to gather information about your history and current symptoms  (e.g. the number and severity of the anxiety attacks, any situations you are avoiding, and how anxiety is affecting your ability to work or attend school).

The cognitive behavioural psychological treatment of panic disorder encompasses:

• information and education about anxiety,
• relaxation and slow breathing training,
• cognitive therapy
• graded in vivo exposure (e.g. if you fear driving will trigger a panic, your therapist will help you devise a graded hierarchy of driving scenarios, for instance at first your therapist might ride in the passenger seat with you, then once you have gained confidence you might drive alone).
• interoceptive exposure  (Panic sufferers confront their feared bodily symptoms associated with anxiety attacks by doing activities which induce the symptoms, e.g. if they fear their heart racing they run up and down flights of stairs, if they fear feeling short of breath they deliberately make themselves hyperventilate).

Assertiveness training may also be given if required. Many people find they improve within 6-8 weeks of treatment, but some people will require more sessions particularly if they have developed severe agoraphobia.

People who experience panic attacks because they have other anxiety disorders such as social anxiety, obsessive-compulsive disorder, body dysmorphic disorder and post traumatic disorder need to seek treatment for their primary complaint too.

People who smoke cigarettes or use cocaine, amphetamines, barbiturates and cannabis are advised to cease using these substances.

People who drink an excessive amount of caffeinated  beverages such as coffee, energy drinks and cola are advised to limit their consumption of these drinks as they can trigger panic attacks.

What medications are used to treat anxiety attacks?

• SSRI antidepressants
• Tricyclic antidepressants
• Benzodiazepines

Benzodiazepines are not recommended for the treatment of panic disorder by the Australian and New Zealand College of Psychiatrists Practice Guidelines (2003) as there is the potential for people to become dependent upon them. If you are currently using benzodiazepines (or any other form of medication)  and wish to cease taking them,  you should consult with your doctor.

Medications should not be ceased abruptly as this can have serious consquences  such as rebound panic. Your doctor can help you wean yourself off the medication safely.

American Psychiatric Association (1994). Diagnostic and Statistical Manual Of Mental Disorders, Fourth Edition, Washington, DC: American Psychiatric Press.

Please note, it is important to consult a qualified mental health practitioner such as e.g. a psychologist or psychiatrist to confirm any diagnosis you think you might have. You must not rely on the information on this site as a substitute for professional medical advice, diagnosis or treatment. No assurance can be given that the information on this site will always include the most recent developments or research with respect to a particular topic.

PSYCHOLOGIST

Catherine Madigan (B.A. Hons., M.A. (Clinical Psychology), M.A.P.S.

Catherine Madigan is a Melbourne Clinical psychologist who focuses on the treatment of anxiety disorders with cognitive behavioural therapy. She has over 20 years experiences dealing with panic attacks whether they occur in the context of stress, agoraphobia, social anxiety, public speaking, exams, post-traumatic stress or OCD.

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The ‘Overcoming Shyness & Social Anxiety’ program teaches cognitive therapy and relaxation techniques (e.g. slow breathing, isometric relaxation) and provides the opportunity for participants to role-play their feared social situations (exposure therapy).

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